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As the health care debate rages in the US, Tokyo lawmakers set a maximum waist size. Are you too fat for Japan?

By David Nakamura — Special to GlobalPostPublished: November 10, 2009 06:29 ET
Updated: November 11, 2009 08:40 ET

Editor's note: David Nakamura also contributes to The Atlantic's excellent Food blog. Read his personal take on this story, which includes the shocking revelation of his own waist size.

TOKYO, Japan — In Japan, being thin isn’t just the price you pay for fashion or social acceptance. It’s the law.

So before the fat police could throw her in pudgy purgatory, Miki Yabe, 39, a manager at a major transportation corporation, went on a crash diet last month. In the week before her company’s annual health check-up, Yabe ate 21 consecutive meals of vegetable soup and hit the gym for 30 minutes a day of running and swimming.

In Japan, already the slimmest industrialized nation, people are fighting fat to ward off dreaded metabolic syndrome and comply with a government-imposed waistline standard. Metabolic syndrome, known here simply as “metabo,” is a combination of health risks, including stomach flab, high blood pressure and high cholesterol, that can lead to cardiovascular disease and diabetes.

Concerned about rising rates of both in a graying nation, Japanese lawmakers last year set a maximum waistline size for anyone age 40 and older: 85 centimeters (33.5 inches) for men and 90 centimeters (35.4 inches) for women.

In the United States, the Senate and House health care reform bills have included the so-called “Safeway Amendment,” which would offer reductions in insurance premiums to people who lead fitter lives. The experience of the Japanese offers lessons in how complicated it is to legislate good health.
Though Japan’s “metabo law” aims to save money by heading off health risks related to obesity, there is no consensus that it will. Doctors and health experts have said the waistline limits conflict with the International Diabetes Federation’s recommended guidelines for Japan. Meantime, ordinary residents have been buying fitness equipment, joining gyms and popping herbal pills in an effort to lose weight, even though some doctors warn that they are already too thin to begin with.

The amount of “food calories which the Japanese intake is decreasing from 10 years ago,” said Yoichi Ogushi, professor of medicine at Tokai University and one of the leading critics of the law. “So there is no obesity problem as in the USA. To the contrary, there is a problem of leanness in young females.”

One thing’s certain: Most Japanese aren’t taking any chances.
Companies are offering discounted gym memberships and developing special diet plans for employees. Residents are buying new products touted as fighting metabo, including a $1,400 machine called the Joba that imitates a bucking bronco. The convenience store chain Lawson has opened healthier food stores called Natural Lawson, featuring fresh fruits and vegetables.

Under Japan’s health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.

Though Japan has some of the world’s lowest rates of obesity — less than 5 percent, compared to nearly 35 percent for the United States — people here on average have gotten heavier in the past three decades, according to government statistics. More worrisome, in a nation that is aging faster than any other because of long life spans and low birth rates, the number of people with diabetes has risen from 6.9 million in 1997 to 8.9 million last year.

“Due to the check up, there is increased public awareness on the issue of obesity and metabolic syndrome,” said James Kondo, president of the Health Policy Institute Japan, an independent think tank. “Since fighting obesity is a habit underlined by heightened awareness, this is a good thing. The program is also revolutionary in that incentivizes [companies] to reduce obesity.”

This from a country where most of the men could shop in the Junior Boys section of our stores....I find this very funny yet sad that we won't even try such a thing yet we make smokers have to walk a mile to a little prison cell sized zone to smoke, but I see a lot of the Japanese tourists smoking like steam engines in Waikiki.......

Coarse edged youth, the irish pendants string from their smiles
not yet plucked as to slacken the seams
and drag down the features of age,
no folds or creases from unkempt wear
eyes of tranquilty, crystalline-beads
no sign of despair in their hair, nor their hearts
but oh they have yet to be experienced and that makes aging so very worth it...ML circa2012